]]>On Tuesday, a U.S. Senate committee held a hearing for the Trump administration’s surgeon general candidate before the full Senate vote on the nomination, expected to happen today. Dr. Jerome Adams, the man who could become the nation’s doctor, is currently Indiana’s health commissioner, a position he was appointed to in 2014 by then-governor and now Vice President Mike Pence.

Trained as an anesthesiologist, Adams is best known for his work on the opioid epidemic. He has advocated for laws restricting the number of pills physicians can prescribe and increasing access to the overdose antidote, naloxone. He is also credited with having convinced Pence to institute a needle exchange program to fight an emerging HIV epidemic in the state. Colleagues say he’s a true public-health advocate, but his views on many issues are unknown and it’s unclear how often he will stand up to an administration likely to take positions that counter best public-health practices.

We know of at least one instance in which Adams allowed a conservative, anti-science agenda to influence his department’s work in Indiana. In September 2015, the Indiana State Department of Health (ISDH) began sending letters to parents reminding them of the importance of vaccinating their children against the human papillomavirus (HPV). The parents had been identified through the state’s immunization records as those who had not yet started the three-shot series recommended by the Centers for Disease Control and Prevention (CDC) as part of routine vaccinations for 11- and 12-year-olds.

One of the parents who received the letter was Micah Clark, head of the conservative American Family Association of Indiana. Clark’s 14-year-old daughter had not yet received the shots. Clark sent an email to his supporters, criticizing ISDH’s vaccine promotion efforts as being part of a “nanny state” and taking away his parental rights. He explained in the email that he’s not anti-vaccine and his daughter was vaccinated against mumps and polio. But he felt vaccinating her against a sexually transmitted disease is “something with completely different moral connotations and risk/benefit considerations.”

His email criticized ISDH’s letter for not emphasizing that HPV is a sexually transmitted disease and for saying that cervical cancer could damage fertility and prevent young people from starting their own families. He argued that since the average age of onset of cervical cancer is 48, most people who get it would have already had the children they wanted.

Clark also noted: “While the ISDH letter expressed many health concerns, it didn’t say that HPV causes anal cancer in gay men at a rate astronomically higher than heterosexuals. Why is that?” His email went on to include numerous myths and misconceptions about the HPV vaccine, such as suggesting it is ineffective and potentially dangerous.

It should be clear to anyone who has followed the debate over the HPV vaccine, as Rewire has been doing for years, why the ISDH letter was not written with Clark’s preferred language. This life-saving vaccine is already working to reduce the rate of HPV. A 2016 study concluded that within six years of the vaccine’s introduction, HPV rates were down 64 percent among teen girls and 34 percent among women in their 20s. In fact, experts estimate that widespread use could prevent 90 percent of cases of cervical, vulvar, vaginal, and anal cancer. Cervical cancer alone kills about 4,100 U.S. women annually.

Yet too often, the conversation gets mired in the fact that HPV is spread through sexual activity, and parents (and politicians) stop focusing on preventing cancer and start worrying about whether young people should be having sex in the first place. Given this discourse, it’s not surprising that the rate of HPV vaccination lags behind all other vaccines.

ISDH’s original letter was clearly aiming to correct this. It read, “Please allow this letter serve as a reminder to contact your health care provider and make an appointment to start the series.” But after Clark’s email went out, Pence began being questioned about the letter. He told the Fort Wayne Journal Gazette: “We certainly want to respect the prerogatives of parents. The role of the state department of health in making information available to families is longstanding. We’ll look into it and make sure it’s clarified.”

A few days later, a new letter was sent out with a very different focus and tone. Instead of starting with cancer risk, the letter stated, “HPV is the most common sexually transmitted infection and is spread through skin-to-skin sexual contact.” It downplayed the potential seriousness of the virus and associated conditions by noting “most HPV infections cause no symptoms and go away on their own.” (This fact was one of Clark’s suggestions.) And it replaced language on how many cancer cases could be prevented with something more generic: “Infection with the virus can lead to cervical cancer in women. It can also cause other genital cancers in men and women, as well as genital warts.”

It is unclear what role Adams himself played in this controversy. We do not know, for example, whether he argued vehemently for the original letter or swiftly agreed to modify it. We only know that the original letter upset Pence’s far-right allies in Indiana and that a second letter was written, all while Adams was heading the IDHS.

Will Adams Put Health First?

On Tuesday, Adams faced questions during a confirmation hearing before the U.S. Senate Committee on Health, Education, Labor and Pensions. He promised to “lead with science …. but I also want to listen to what stakeholders and patients are saying.”

Experts across the country have suggested that Adams will stand up for public health over ideology. Dr. Joshua Sharfstein, an associate dean at the Johns Hopkins Bloomberg School of Public Health, told the New York Times: “From everything I’ve seen, Dr. Adams is a very serious and capable physician and public health official. This is an opportunity to speak to the problems as they are and not as they are viewed through an ideological prism.” In the same article, Charles Rothenberg, president of the Medical Society of the State of New York, echoed the sentiment that “Dr. Adams has a proven track record to make public health a priority despite political hurdles.”

Indeed, Adams is credited with stemming an HIV epidemic in rural Indiana by convincing Pence to overcome his own negative opinions on needle exchange. A month into Adams’ tenure at IDHS, the first cases of HIV in rural Scott County were reported. Within a year, there were 181 cases in a town with fewer than 5,000 residents. The virus was being spread through needles used to inject prescription painkillers. At the time, the state banned needle exchange programs but, perhaps at the urging of Adams, Pence launched an emergency clean needle program.

While the needle exchange reversal is often pointed to as proof of Adams’ ability to stand up to political opposition, critics felt this change of heart on needle exchange came far too late.

Adams later wrote of the decision: “No matter how uncomfortable syringe service programs make us, they are proven to save lives, both by preventing the spread of diseases like HIV and hepatitis C, and by connecting people to treatment that can put them on a path to recovery.”

In Tuesday’s hearing, Adams spoke about a conversation he had with a local sheriff who was concerned about needle exchange “and the revolving door of his jail” for people arrested for drug offenses.

The “biggest lesson” Adams gleaned from these community discussions and trying to address the HIV situation in Scott County was that “science and evidence is necessary, but it’s not always sufficient” to effect change.

It’s Hard Being at the Top

Surgeons general wield little power except that of persuasion when they use their office to shine a light on issues they deem priorities. They tend to get the most attention when their positions differ with those of the administration that appointed them.

Dr. C. Everett Koop, for example, was the surgeon general under Ronald Reagan when he was asked to write a report about what anti-abortion opponents call post-abortion stress syndrome (and which public-health officials say is non-existent). Koop had been chosen for the role, in part, for his own personally conservative views on abortion. Yet, after going over the evidence, rather than write a report, he issued a letter saying there “was no unbiased, rigorous scientific research on the effects of abortion on women’s health that could serve as the basis for a Surgeon General’s report on the issue.” Anti-choice groups, however, later used Koop’s letter in challenging the U.S. Supreme Court’s Roe v. Wade decision, reported the New Scientist in 1989.

Koop also pushed the Reagan administration to respond to the emerging HIV and AIDS crisis, and he was ultimately responsible for a report that called for condom use, condom education, and sex education starting in third grade.

Dr. Joycelyn Elders, who served under Bill Clinton, sparked frequent controversy for her views on sex education. She spoke out in favor of making contraception available in school and criticized the Catholic Church for its anti-abortion stance. But it was backlash to comments she made at a conference on World AIDS Day 1994 that ultimately lead to her resignation. When asked about masturbation, she said: “I think that [masturbation] is something that is part of human sexuality, and it’s part of something that perhaps should be taught. But we’ve not even taught our children the very basics.” This was just too much for some opponents, and the Clinton administration, which was reeling from Newt Gingrich’s recent takeover of the U.S. House of Representatives, wanted no part of the controversy.

In 2007, Dr. Richard Carmona accused the George W. Bush White House of watering down or even suppressing important public health reports for political reasons. He was not asked back for a second term.

It remains to be seen what issues Adams will highlight if confirmed, though he mentioned the opioid crisis and engaging workplaces in improving the nation’s health during Tuesday’s hearing. Colleagues note he has been passionate about curbing tobacco use and reducing the infant mortality rate in Indiana. He has spoken in favor of Indiana’s Medicaid expansion program, but it’s unclear whether he likes all such programs (which are now on the GOP chopping block) or was fond of the conservative elements that Pence worked into his state’s program. Adams said of the program known as Healthy Indiana 2.0, “I’m convinced it’s going to give people access, it’s going to provide better health care, and it’s going to transition our citizens … to be able to work and better themselves as opposed to trapping them in an income-based entitlement program.”

And, of course, there’s no way to know whether he’ll be the voice of public health reason in an administration that has of yet seemed uninterested in science, health, or even facts.

]]>House GOP: Eliminate Family Planning Services for Low-Income Familieshttps://rewire.news/article/2017/07/13/house-gop-eliminate-family-planning-services-low-income-families/
Thu, 13 Jul 2017 13:42:49 +0000https://rewire.news/?post_type=article&p=104878Republicans have long wielded the appropriations process against Title X. This effort marks the latest House GOP attempt to do away with the program.

]]>Republicans in the U.S. House of Representatives are again proposing to zero out federal Title X family planning funding to health-care providers that serve people with low incomes.

A House appropriations subcommittee Thursday afternoon will begin marking up the fiscal year 2018 Labor, Health and Human Services, and Education (Labor-HHS) funding bill purporting to cut “low-priority programs” while investing in “essential health.” The bill axes all funding, about $300 million, for what Republicans on the committee called the “controversial” Title X program.

Republicans have long wielded the appropriations process against Title X. This effort marks the latest House GOP attempt to eliminate the program. The House did not release a draft Labor-HHS proposal the two years in which it escaped the GOP’s wrath.

Title X-subsidized providers serve a diverse population of people with low incomes. Of the four million Title X patients, 30 percent self-identified as Black or African American, Asian, Native Hawaiian or Pacific Islander, or American Indian or Alaska Native; 32 percent self-identified as Hispanic or Latino; and 13 percent had limited English proficiency, according to U.S. Department of Health and Human Services (HHS) data from 2015.

Planned Parenthood receives about $60 million in federal Title X funds, per nonpartisan Congressional Budget Office data from 2015. The health-care organization’s affiliates treat about 1.5 million patients through Title X, according to internal accounting.

“The unintended pregnancy rate is at a record low and the rate of teen pregnancy is at a 30-year low. If Title X is eliminated, we will reverse those public health gains,” NFPRHA President and CEO Clare Coleman said in a statement.

“Women will be more vulnerable to STDs and at a greater risk of unintended pregnancy and poor birth outcomes. This subcommittee bill must go no further.”

]]>In Rural America, We Need Sex Ed Along With Accessible Reproductive Health Carehttps://rewire.news/article/2017/06/12/rural-america-need-sex-ed-along-accessible-reproductive-health-care/
Mon, 12 Jun 2017 21:41:47 +0000https://rewire.news/?post_type=article&p=103980Sexual health is a lifetime responsibility, and we need to equip young people with the tools they need.

]]>Rural communities like mine stand to be particularly harmed by the Trump administration’s efforts to eliminate key provisions of the Affordable Care Act (ACA). These changes come at a time when sexual health education has declined disproportionately in rural areas. A lack of comprehensive sexual health education, paired with the rolling back of ACA gains in rural communities, will exacerbate an already dire situation.

As reproductive rights advocates fight for expanded access to health-care services, we must also continue working to ensure that schools and community programs are providing education on contraceptive options and other sexual health issues. These issues are inextricable: Without equipping our community with knowledge about their own bodies, how will we move the needle forward in any way?

I am a mother of two children in Visalia, California, schools—the same system I attended as a kid. Our county, Tulare County, went 56 percent for Trump in the presidential election. At the same time, our county is home to a thriving community that supports, depends on, and could greatly benefit from expanded access to contraception, including young families, LGBTQ people, and women. We all have the right to decide if, when, and how we will parent.

And yet, sexual health education and other critical services are still hard to come by. Fewer than 10 percent of U.S. physicians practice in rural areas, according to Stanford eCampus Rural Health. Often rural residents need to travel significant distances just to reach a health-care provider, which can require us to take time off work and pay for transportation and other costs like child care. Once we reach a health center, rural residents are disproportionately dependent on Medicaid to get health coverage, which is under threat by congressional Republicans’ effort to defund Planned Parenthood and repeal the ACA.

I volunteer in a group that informs the community about the Healthy Youth Act (which requires sex education in California schools) and school districts about the implementation of the law. As part of this group, we receive sexual health education, including anatomy lessons, in-depth contraceptive information, a condom demonstration, and more. I could plainly see how important and informative these lessons would be in schools. It might be the only time that adolescents receive sexual education of any kind. It cannot be assumed that each child is receiving supplemental sex education at home, or that what their parent or guardian teaches them is medically accurate and unbiased.

At one point it occurred to me that my fellow volunteers and I receive a more comprehensive sexual education experience in our meetings than what was offered to me in my public school, and not much has improved since I was a student.

The number of rural girls receiving birth control information actually has declined in recent years, from 71 percent to 48 percent, and among boys from 59 percent to 45 percent, according to the Guttmacher Institute. Although my district teaches Positive Prevention Plus, which abides by state guidelines, in some ways, a sex ed curriculum is only as good as the leadership that teaches and believes in it.

In my quest to learn more about what curriculum is implemented in Visalia schools, I contacted a health director by phone and a school principal in person. Appallingly, I was not only met with attitudes and tones of annoyance at any and all questions concerning sex education, but unapologetic carelessness about having the third-highest rate in the state for teen pregnancy, and sexually transmitted infection (STI) rates through the roof, in our county, with very few resources available for the most at-risk populations. The health director stated that “condom demonstrations are not proven to be effective,” and the principal said that “Planned Parenthood only served one agenda,” which I interpret to mean he believes health centers and organizations that provide reproductive and sexual health care have some kind of nefarious intent, rather than the simple truth that they provide some of the only resources to young people in our community.

Research and personal experience tell me the opposite of what school officials claim: You don’t just go to a reproductive and sexual health clinic for abortions, but to learn about birth control options, get screened for cancers and STIs, and learn about your body as a whole.

It is clear that people with these perceptions of reproductive health care will continue to be ineffective at helping to promote positive change in our community. They’ve left it up to community organizations—like the Source LGBT+ Center, and ACT for Women and Girls, which I participate in—to fill the void on sexual health education, contraceptive access, and reproductive justice as a whole.

Sexual health is a lifetime responsibility, and we need to equip young people with the tools they need.

Only as an adult have I come to understand that public health depends on health education, particularly sexual education. I would much prefer that my kids learn about the responsibility of having safer sex than learn the responsibility of being a reluctant teen parent. And no matter what choices my kids make, I want them to have the knowledge they need to make informed decisions, with confidence and resources.

Between a lack of quality sex education (which may only get worse with the help of the Department of Health and Human Services’s recent hire) and added barriers to contraception and reproductive health care coming out of Washington, rural America must fight back against both national and local barriers to women’s health and freedom. We need to put the pressure on our local lawmakers, and let school officials know that sexual health education and access to resources are priorities among parents as well as adolescents.

Knowledge is power, and I intend for my two kids to grow up to be powerful community leaders.

]]>A ‘Fitbit’ for Your Penis: Is It a Good Idea to Track Sexual Stats?https://rewire.news/article/2017/04/07/fitbit-for-penis-is-it-a-good-idea-to-track-sexual-stats/
Fri, 07 Apr 2017 18:27:40 +0000https://rewire.news/?post_type=article&p=101642I'd like us to question not just whether such a device is necessary—given that people have been boning for millennia without tracking their genital data—but if it's even wise.

]]>Earlier this year, British manufacturers announced the “i.Con,” which they’re billing as the first “smart condom.” This, despite the fact that it isn’t a condom at all, but a ring worn around the base of the penis and over an actual condom.

According to the creators, British Condoms, the wearable device—which is still in prototype form—has a nanochip that records data during sex and sends it to an app on your smartphone so you can keep track of your performance, share stats with a friend, and compare your sexcapades to those of other people around the globe. It can track the number and speed of thrusts, the number of times you change positions, and the length of the sex session. It also measures the girth of the penis and its skin temperature, and tells you how many calories you’ve burned (don’t get excited, on average sex burns fewer than 100 calories in 25 minutes). And though they have not revealed how, the manufacturers promise the final product will be able to test for sexually transmitted infections (STIs) in partners.

The manufacturers say that more than 96,000 people have preregistered for the i.Con, which will reportedly be available in Britain later this year. Before thousands of people shell out $74, I’d like us to question not just whether it’s necessary—given that people have been boning for millennia without tracking their genital data—but if it’s even wise.

Testing for STIs in the Heat of the Moment

Let’s start with the STI testing component. Two years ago, British teens made headlines when they won a contest for designing a condom that would theoretically change colors when it came in contact with STI antibodies in semen or vaginal fluid. Like the i.Con, this condom was not actually market ready—in fact, it was nothing more than an idea at the time of the contest. At the time, I suggested for Rewire that it might be better if such a concept remained theoretical:

I don’t think the heat of the moment is the best time to find out whether you or your partner has an STI. It’s a very vulnerable time to give or receive that kind of news, especially unexpectedly. At a minimum it could be painfully embarrassing; in the worst-case scenario, I fear it could provoke a potentially violent reaction.

The same concerns hold true for the i.Con, but this one seems even worse. Though the i.Con mechanism may also test the person wearing the device, the implication would be that it’s working for them by testing their partners. This is actually a little backward, because in general, the penetrated partner is far more at risk of contracting an STI than the insertive partner.

More importantly, it feels very one-sided. Instead of a condom’s joint effort in prevention, this feels more like an alarm that goes off if the wearer’s partner is found to have an infection. Plus, if a person is wearing it over a condom as the manufacturer suggests, it’s not entirely necessary, as they have already protected themselves and their partner from many STIs.

Of course, that’s only true if the technology works. And it is not yet clear how the device would test for STIs, which STIs would be included, and how susceptible the test would be to false positives. All we have is the word of the manufacturers, who promise that it will “have built-in indicators to alert the users to any potential STIs present.” This feels suspect to me as no one method can test for all potential STIs; some, such as syphilis and HIV, are found through blood tests.

It Seems to Always End Up on the Internet

Just last month, Canadian sex toy maker, We-Vibe, settled a lawsuit for $3.7million after it was accused of violating wiretap and eavesdropping laws by collecting data from users. As Rewire reported when the suit was first filed, the We-Vibe Connect allowed couples to text, video chat, and control the device from a distance if they downloaded a corresponding app. What some users didn’t know was that the app also allowed the company to collect data on the device use—including speed of vibration and temperature of the device—in real time.

The i.Con is different because users will be fully aware that they are sharing their data with some chosen people—it’s one of the selling points. Still, the We-Vibe situation is relevant because it calls into question the safety of sharing and storing sexual data, and it shows how these apps can be less secure than promised. Even before the lawsuit was filed, the We-Vibe Connect made headlines when hackers announced that they had found a way into the app that allowed them to control the vibrator from afar.

Putting sexual data out there has the potential to embarrass everyone involved when it leaks. Maybe your girlfriend finds out that you burned a lot of calories having sex when she was out of town, or your boss realizes that you reached your personal best thrust speed on a day you called out sick.

We live our lives out loud and online these days, and it can be hard to reconcile the ease of the digital world with potential invasions of privacy. Never shopping online again would be extreme, but this one seems easy: Just don’t put the information out there. Better yet, don’t collect it at all.

Tracking Our Sexual Performance

The i.Con is essentially promising to answer the age-old question, “Am I good in bed?” The ads ask: “Ever wondered how you stack up to other people from around the world? Welcome to the future of wearable technology in the bedroom. Welcome to i.Con.”

I’d like to think that most people don’t lie awake wondering if they’re good lovers, not because the answer is irrelevant but because they’ve already checked in with the person (or people) they’re sleeping with—the only ones whose opinions really matter.

I’d also like to think that we’ve all gotten past the notion that bigger, faster, or harder is the way to measure good sex. Sure, the i.Con can tell you how many times you thrusted or how long sex lasted, but this data isn’t going to tell you whether a good time was had by all. Many women, for example, need direct clitoral contact to have an orgasm. Thrusting harder than the next guy does not mean that you even found your partner’s clitoris, let alone stimulated it in just the right way. Changing positions over and over again might be a sign of a marathon session where you couldn’t get enough of each other, or it might just mean that one of you couldn’t get comfortable. And I have no idea why skin temperature of the penis would ever be relevant.

Tracking sex stats also doesn’t just perpetuate inaccurate ideas of what makes a good lover; it promotes the idea of sex as a contest. Wanting to be “better” than a friend or even than yourself the last time appeals to the most competitive parts of ourselves. This is where wearable fitness devices made their mark—their intention was not just to track your fitness habits, but to change your behavior. If you set a 10,000-step goal for yourself but fall short by only getting 7,500 today, you will likely be that much more motivated to top 8,000 tomorrow.

By prompting similar urges to compete with ourselves and others, the i.Con promotes goal-oriented sex at its worst. The goal isn’t even getting to orgasm, it’s taking a path that beats the stats Phil showed you last night or the ones you recorded last week. Instead of concentrating on your partner’s verbal and physical cues, you could easily get wrapped up counting thrusts, changing positions one more time, or watching the clock to make sure you last just a little bit longer.

Sex is not about data: We can’t use Nate Silver algorithms or Moneyball trading tactics to make it better, and this is not the place to look at the big picture or play the long game. We have to take it moment by moment and just try to feel good. If we want to know how good it really was or if there’s anything we could do better next time, we don’t need to look at an app—we need to talk to our partner. What felt good? Did anything hurt? Did you like it when I did that? Was it better than that time in Cabo?

A Fitbit for your dick cannot answer any of these important questions, and I assure you, it will not make you a better lover.

]]>Stop Missing the Point: Sex Ed Is a Human Righthttps://rewire.news/article/2017/03/06/stop-missing-point-sex-ed-human-right/
Mon, 06 Mar 2017 19:26:57 +0000https://rewire.news/?post_type=article&p=100243Ensuring that all people—and especially young people—have a complete and accurate understanding of how sexuality can shape and affect us is a necessary and moral thing to do.

]]>I’m going to pose an awkward truth: When it comes to sex ed in the United States, supporters and critics alike are missing the point.

Sexuality is a fundamental part of who we are; to deny that is to deny a person’s humanity. That’s why we, as sexual and reproductive health, rights, and justice advocates, must promote sex ed not just as a health need but as a human right. Ensuring that all people—and especially young people—have a complete and accurate understanding of how this core part of our identities can shape and affect us is a necessary and moral thing to do.

Right now, in the United States, too much of the sex ed conversation, instruction (both inside and outside of schools), and funding focuses on risk reduction, as in disease or pregnancy prevention. While promoting medically accurate information about contraception, pregnancy, and sexually transmitted infections (STIs) is critical, it’s not the full A to Zs of sexuality education. That full range includes key components of health and well-being such as being able to communicate needs, wants, and desires; developing relationships with people; setting boundaries; and learning that you have a right to be treated with dignity and respect, no matter your identity.

With CSE, young people are provided medically accurate instruction—which is appropriate based on age, development, and culture—throughout their K–12 school years. Curricula adhering to the minimum criteria outlined in the National Sexuality Education Standards incorporate aspects of sexuality that go beyond sexual health or even sexual behaviors like using condoms and contraception, and yes—of course—abstinence. It’s a holistic approach to learning about your body; about different ways of communicating and establishing relationships of all kinds with peers, partners, parents, and society; and about having autonomy to assess and challenge the injustices that our culture perpetuates around sexuality.

Comprehensive sexuality education is a core building block from which to destigmatize reproductive health-care options, including abortion, and support healthy relationships from a position of equity and empowerment. In short, CSE is foundational in developing and sustaining an equitable and just understanding of ourselves and others.

Let’s be clear, comprehensive sexuality education is happening in some of the nearly public 14,000 school districts across the country. In 2015, California passed the Healthy Youth Act, which requires elements of CSE from middle school onwards. And last year, the Omaha Public Schools district adopted new standards for sex education for middle and high school students.

This patchwork approach, however, leaves far too many young people without access to even the most basic information about sexuality.

National leadership eliminating abstinence-only funding once and for all and supporting comprehensive sexuality education in schools would go a long way toward ensuring the rights of the about 50 million young people in public schools today.

Unfortunately, for far too long, proponents of abstinence-only programs have perpetuated a “just say no” agenda supported by more than $2 billion in federal funding since 1982. For 35 years, the predominant federal (and often state) approach to sex ed has been ideologically driven, shaming and stigmatizing sexuality, whether we are discussing the act of sex itself or a broader understanding of our sexual identities. Not surprisingly, this perspective that sex is dangerous has affected how some parents, educators, policymakers, and advocates have approached discussions about sexuality for young people. Despite progress that was made under the Obama administration in the establishment of funding streams for research-based programs to support adolescent sexual health, which can include sex ed, the perception of sex and sexuality as a risk to young people also enabled a 55 percent increase in abstinence-only funding last year alone.

Now, the threat of a continued resurgence of abstinence-only programs in place of sex ed is all too real under this administration and a Republican-controlled Congress. By driving funding toward these shaming and stigmatizing programs, the federal government helps perpetuate harmful ideas about young people and sexuality.

Abstinence-only programs not only dictate particular choices to young people (no sex until marriage, only heterosexual marriage can be considered marriage, you’re “damaged goods” if you have sex, getting pregnant as a teen condemns you to a life of poverty, etc.) without regard to their lived experiences, they also perpetuate the endorsement of ideological over educational content. Program content that intentionally or inherently withholds or misconstrues information is not education.

And while all the right phrases are turning up in newer abstinence-only promotional materials, terms like “healthy relationships” and “communication skills” all come back to saying “no” to sexual activity before marriage. These programs are not talking about bodily autonomy, consent, or condom use negotiation, but rather reinforce stereotypically gendered, queer-excluding narratives about sex.

Particularly troubling, abstinence-only programs treat pregnancy as the worst thing that could possibly happen to a young person, with proponents and even federal funding promoting the prescriptive “success sequencing for poverty prevention” (i.e. graduate from high school, get a job, get married, then have children). Perhaps not surprising to many of us, this pathway to “success” generally only holds true if you’re white.

So much of what is ignored in abstinence-only programs is centered around systemic inequities that people of color, those with low-incomes, LGBTQIA+ individuals, and other marginalized communities face. Abstinence-only programs—and, to a greater extent than should make sex ed advocates comfortable, disease and pregnancy prevention evidence-based programs—expect a young person to ignore their whole self and their lived experience to get information in a vacuum.

On the other hand, comprehensive sexuality education addresses a young person’s lived experience and says “I see you. All of you. And you deserve to be treated with dignity and respect so that you can live a healthy, fulfilled life that is right for you.”

If we’re going to make the kind of progress we need at local, state, and federal levels in preventing the spread of abstinence-only programs and encouraging the adoption of comprehensive sexuality education, we as sexual and reproductive health, rights, and justice advocates and activists must embrace this truth: Sexuality education is a human right. It’s time we start fighting for it.

]]>Medicaid Block Grants Could Do ‘Irreparable Damage’ to Safety Net of Family Planning Providershttps://rewire.news/article/2017/03/03/medicaid-block-grants-could-do-irreparable-damage-to-safety-net-of-family-planning-providers/
Fri, 03 Mar 2017 20:13:26 +0000https://rewire.news/?post_type=article&p=98627Because block grants essentially cap how much the government allocates each year to states, restructuring the program in this way could also hinder a state’s ability to deal with a public health crisis or an economic downturn should one arise.

]]>When then-Republican presidential nominee Donald Trump penned a letter to anti-choice activists urging them to support his campaign, he included a promise to defund Planned Parenthood. Weeks before Trump’s inauguration, Republicans in Congress began taking steps to remove the reproductive health-care provider from federal funding programs through a budget reconciliation process. Now Republican efforts to restructure Medicaid into block grants could help make that a more permanent reality.

Doing so would give Republicans in both state legislatures and the U.S. Congress, who were already eager to defund Planned Parenthood, the opportunity to eliminate the provider from Medicaid, but experts say the devastating effect on reproductive health could go far beyond that.

Medicaid is a joint federal and state program that currently serves almost 75 million people and is the “single largest source of health coverage in the United States,” according to Medicaid.gov. That includes half of all people with low incomes, two in five children, and two in five people living with disabilities. As an “entitlement,” anybody who qualifies for the public health insurance coverage is guaranteed to be accepted into the program. “It also means that states have guaranteed federal financial support for part of the cost of their Medicaid programs,” according to the Center for Budget and Policy Priorities (CBPP). To get that federal funding, states must agree to cover “mandatory” populations such as pregnant women whose incomes fall below 133 percent of the poverty line—though who qualifies beyond the federal government’s minimum standards varies from state to state and depends on whether a given state expanded their program through the Affordable Care Act.

In addition to its general role in ensuring those with low incomes can get the care they need, Medicaid also plays a crucial part in access to family planning services. What this means varies from state to state, but Audrey Sandusky, the director of advocacy and communications at the National Family Planning & Reproductive Health Association (NFPRHA), told Rewire it typically includes services such as contraceptive counseling and care—including a full range of contraceptive methods—as well as screenings for sexually transmitted infections (STI) and cancer.

The program has been the primary public funding source for family planning “since the 1980s, particularly in states that have expanded their Medicaid eligibility for family planning,” according to NFPRHA. As the Guttmacher Institute notes in a September 2016 fact sheet, “Medicaid accounted for 75% of 2010 expenditures on family planning, state appropriations accounted for 12% and Title X for 10%. Other sources, such as the maternal and child health block grant, the social services block grant and Temporary Assistance for Needy Families, together made up 3% of [public] expenditures.”

But health-care policy experts say Republican plans to reform Medicaid could have a major impact on the provision of family planning services.

Under a block grants system, the federal government would set aside a fixed amount of money for Medicaid for each state to decide what to do with. Doing so “would institute deep cuts to federal funding for state Medicaid programs,” according to the CBPP. An analysis of Republican health-care proposals published by the Center for American Progress last year noted previous estimates found “that past House Republican block grant proposals would have eventually resulted in 14 million to 20 million Medicaid beneficiaries losing coverage.”

Given the critical role Medicaid plays in publicly funded family planning in the United States, cutting back on the program at large would likely reduce funding for reproductive health care on a state level. The federal government currently employs a 90 percent match rate for states’ funding family planning services through the program. That means that the federal government matches 90 percent of what a state pays from its own Medicaid funding buckets for family planning. “Presumably in a block grant that kind of an incentive to offer family planning services would be gone,” said Diane Rowland, executive vice president at the Kaiser Family Foundation, during a January press briefing on the entitlement program.

Reproductive health-care advocates and organizations roundly condemned such changes in a May 2011 letter responding to such a plan in the House Budget Committee budget for 2012. The National Family Planning & Reproductive Health Association, the American Congress of Obstetricians and Gynecologists, the Association of Reproductive Health Professionals, the Center for Reproductive Rights, the National Partnership for Women & Families, Planned Parenthood Federation of America, among others, said the plan would force “many poor and low-income individuals to go without care or to seek care in our nation’s emergency rooms, resulting in increased health care costs.”

The organizations noted the key role that publicly funded family planning services—which Medicaid is the largest source of funding for—play in reducing unintended pregnancies.

“In 2014, publicly funded family planning services from all sources (including safety-net centers and private doctors who accept Medicaid) helped women to avoid about two million unintended pregnancies, which would have resulted in nearly one million unintended births and nearly 700,000 abortions,” according to the Guttmacher Institute.

Adam Sonfield, senior policy manager at Guttmacher, explained in a January interview with Rewire that under block grants, “fewer people would have Medicaid most likely, and those that do would probably have less comprehensive coverage. And that’s clearly a bad thing when it comes to health care generally and reproductive health specifically.”

If Medicaid were restructured to block grants, states would also have more flexibility to determine which services they want to cover. That “would likely give states more ability to cut back on specifically on the reproductive health services they provide,” said Sonfield.

Though public insurance in most states currently covers many related services such as Pap smears and STI testing, “given some of the hostility we’ve seen in some states towards reproductive health care and coverage, if states had the flexibility to not include family planning services,” to charge copayments and deductibles for them, or to limit provider choice, Sonfield suggested some are likely to do so.

Sandusky, whose organization represents both family planning providers and administrators, noted that Medicaid “underpins the ability of our providers to deliver care.” She said restructuring the program to a block grant could mean “an untold number of people will not be able to see their provider of choice, either because they will have to pay out-of-pocket, or health centers would have to close their doors.”

That “would do irreparable damage to the safety net at a time when demand for publicly funded family planning continues to grow,” said Sandusky.

While most Medicaid enrollees are currently allowed to seek family planning care at any provider they want—including those that are out of network—giving states more flexibility to decide on their own rules could mean that changes. “We certainly have seen several states try to get rid of the freedom of choice protection,” said Sonfield. “States have been targeting that provision, particularly around Planned Parenthood and other [clinics that] provide abortion services without federal dollars.”

In late February, a federal court in Texas issued an injunction against the state’s attempt to do just that. The order temporarily halted state lawmakers from cutting Planned Parenthood out of the state’s Medicaid program. As Rewire Vice President of Law and the Courts Jessica Mason Pieklo explained, “The fight over Planned Parenthood funding in Texas centers on Medicaid’s ‘free choice of providers’ requirement. In other words, Medicaid recipients have the right to choose among a range of qualified providers without government interference.”

Lawmakers in Texas attempted to use a discredited anti-choice group’s deceptively edited videos to justify removing Planned Parenthood from the program. Though the Texas court may have ruled against the state’s attempt, “the new presidential administration means other states have new motivation to keep trying to use Medicaid as a vehicle for defunding Planned Parenthood,” wrote Pieklo.

The more restrictions on services and providers that are put on the program, “the harder it would be for Medicaid enrollees to make use of their coverage the way everyone else makes use of their insurance coverage, to meet their own health-care goals—including their reproductive health-care goals,” Sonfield said.

Given the efforts of Congress in the past, Alina Salganicoff, director of women’s health policy at Kaiser Family Foundation, told Rewire in mid-February it was possible “they [could] put in language into the Medicaid block grant limiting participation of providers that also provide abortion services.”

Though she stressed it’s difficult to predict specifics without any actual legislation or detailed proposals, “Congress has shown intense interest in eliminating Medicaid as a source of funding for Planned Parenthood,” she said.

Like the lawmakers in Texas, Republicans around the country have spent years embarking on a massive crusade to undercut and eliminate funding for Planned Parenthood. Efforts by the discredited Center for Medical Progress to smear the provider only served to ramp up the GOP’s efforts, even as countless investigations turned up no evidence of wrongdoing.

While the Obama administration repeatedly moved to block Republican efforts to defund Planned Parenthood, a Trump administration has given the GOP renewed hope for accomplishing their goals. House Republicans moved just weeks ago to overturn Obama’s efforts to safeguard funding for family planning providers.

Those attacks are likely only the beginning, and Medicaid reform may be the way to help the party achieve its goals. Sandusky said that her organization is “absolutely anticipating major threats to the safety net either through provider restrictions or funding cuts or a fundamental restructuring of the Medicaid program.”

Because block grants essentially cap how much the government allocates each year to states, restructuring the program in this way could also hinder a state’s ability to deal with a public health crisis or an economic downturn should one arise.

“Under the current financing structure federal funds are tied to actual costs, program needs and state policy decisions,” explained Robin Rudowitz, an associate director for the Program on Medicaid and the Uninsured at the Kaiser Family Foundation, in a January issue brief. “If medical costs rise, more individuals enroll due to an economic downturn or there is an epidemic (such as HIV/AIDS) or a natural disaster (like Hurricane Katrina), or new treatments (like drugs for hepatitis C), Medicaid can rapidly respond and federal payments automatically adjust to reflect the added costs of the program,” wrote Rudowitz.

That may not be the case anymore with block grants. “Currently, the federal government and states share in those unanticipated costs,” wrote CBPP’s Edwin Park in a brief for the organization. “Under a block grant, however, states alone would bear them.”

Though some Republicans, as NPR put it, “have advocated block grants as a way to cut the Medicaid costs”—a claim unsupported by evidence—what they’re really talking about is taking away patient’s access to essential health care. While we may not have enough details about the party’s supposed “plan” to change the program to know exactly how it may play out, it’s clear that regardless of how they do it, block grants could open the doors to millions of people losing their access to critical reproductive health care.

]]>Oregon Democrats are advancing legislation to require insurance coverage of reproductive health services, including abortion care, and to lock in mandatory coverage of free birth control across the state.

The legislation comes as Republicans in Congress take steps to dismantle the Affordable Care Act (ACA). The health-care reform law requires insurance companies to cover a range of contraceptives without a co-pay, a benefit supported by 71 percent of Americans.

That benefit appears likely to disappear with Republicans in control of Congress and the White House.

Oregon joins others states, such as Minnesota, Colorado, Massachusetts, and New York, where Democratic lawmakers are advancing bills to make mandatory insurance coverage of free contraception, as Reuters reported.

House Bill 2232 in Oregon goes further by promising insurance coverage of a range of reproductive health services, including STD testing, pre- and post-natal care, and abortion.

The legislation is a marked departure from much of the country, but Oregon is one of the few states in which Democrats control both legislative chambers and the governor’s office. Half of states restrict abortion care coverage in insurance plans offered through ACA exchanges, and ten states extend the restrictions to private insurance plans, according to the Guttmacher Institute.

“All Oregonians should have access to the full range of reproductive health care, starting with preventive care and continuing through postpartum care,” Laurel Swerdlow, advocacy director for Planned Parenthood Advocates of Oregon, said in a statement.

The bill bars discrimination in insurance coverage based on gender identity, among other protections. The legislation also carves out a religious imposition exception.

“Transgender and gender-nonconforming Oregonians need access to services often categorized as ‘women’s health care,’ including gender-specific cancer screenings,” said Kara Carmosino, program director for Asian Pacific American Network of Oregon, in a statement. “Unfortunately, when coverage is dependent on one’s gender marker, procedural barriers can hinder access to this necessary and lifesaving care.”

]]>What Will the Trump Presidency Do to Sexuality Education? Advocates Aren’t Hopefulhttps://rewire.news/article/2017/01/09/will-trump-presidency-sexuality-education-advocates-arent-hopeful/
Mon, 09 Jan 2017 20:55:05 +0000https://rewire.news/?post_type=article&p=97439The incoming Trump administration hasn't telegraphed any changes, and local governments maintain much control over what children are taught. But the federal government funds programs nationwide and can steer resources to programs that it prefers.

]]>When I started my sexuality-education career in the late 1990s, the pendulum was swinging away from the comprehensive programs that had been instituted in response to the rising HIV epidemic. Congress had just allocated a big chunk of money to teach young people that sex outside of marriage would have inevitable harmful effects. Though abstinence-only-until-marriage programs were not new, what had once been the province of religious institutions earned the federal stamp of approval, and states were funding programs that compared having sex outside of marriage to starting a fire in the middle of your living room instead of your fireplace.

And all of this was happening under the Democratic administration of President Bill Clinton.

Since then, I’ve watched changes with every administration. When George W. Bush took office a few years later, the push for these moralistic programs masquerading as teen pregnancy prevention grew stronger. By the end of his administration, abstinence-only-until-marriage programs were receiving $176 million per year. Then came the Obama administration, and the pendulum swung back a little bit. Some funding for abstinence-only-until-marriage was cut (though Congress made sure these programs didn’t disappear), new guidance toned down the abstinence rhetoric, and funding was finally made available for evidence-based teen pregnancy prevention programs.

Now it’s time for a new administration to take over. Since neither President-elect Donald Trump nor his advisors have shared any thoughts about sexuality education, advocates don’t know what to expect yet. But many are not optimistic.

Local Control, But Federal Purse Strings

The bright spot in the future of sex education is that as influential as federal policy can be, the final word on what gets taught is decided much closer to home. Debra Hauser, president of Advocates for Youth, told Rewire that local control will be key to sustaining the progress that has been made in instituting high-quality sexuality education in communities across the country.

Her organization was instrumental in the 2011 creation of the National Sexuality Education Standards, which were developed to address the inconsistent implementation of sexuality education nationwide. The standards outline the minimum essential content that should be included in sex education and the skills young people should acquire by certain grade levels. Advocates for Youth also authored a curriculum that provides teachers of all grade levels with lesson plans that address the topics covered in the standards.

Hauser said that this curriculum has gone out to more than 4,000 teachers, and that five of the ten largest school districts in the country are using it to fill gaps in their existing programs.

Hauser points to successes in improving sexuality education in large school districts like Clark County, Nevada, and Broward County, Florida. Clark County, which includes Las Vegas, is the fifth-largest school district in the country. This summer, its school board voted to expand sexuality education to include more information about important topics such as contraception (including where students could access birth control) and sexually transmitted infections (STIs). Broward County made a similar decision two years ago when it voted to overhaul sex education. Students from kindergarten through fourth grade learn about anatomy and personal safety, while students in the fifth through 12th grades now learn about a wide range of topics including dating violence, STI prevention, sexual abuse prevention, and sexting.

But Hauser acknowledges that a change in funding on the federal level will affect local communities, especially those in conservative states. Still, she said, “it’s hard to believe that a flip of a switch would turn back this kind of progress.”

That’s partly because the federal government has little direct input into the sexuality education that is taught in most schools across the country. Rules about whether schools must address sexuality, what topics must be taught, and what cannot be said all come from the state. Specifics about textbooks and curricula are most often decided by local school boards. Some money for programs also comes from the state.

The federal government does have a say, however, on sex education both in and out of schools.

The administration, Congress, and government agencies like the Department of Health and Human Services (HHS) all play roles in creating additional funding streams, allocating money, and deciding what programs need to look like in order to qualify for that money. Some of these funds—such as the Teen Pregnancy Prevention Program (TPPP)—are administered directly by the HHS, which means the agency decides which organization gets the money and what it does with it. Others—like the Title V abstinence-only funding stream—are given to states in the form of block grants, and the state decides exactly which programs to fund.

Funding May Get Cut (Or Increased)

Under the Bush administration, when abstinence-only was king, we saw a proliferation of such programs, the growth of an entire industry to support them, and legislation that supported an abstinence-only approach. Even states that had previously had comprehensive sex education were susceptible to legislation supporting abstinence.

Though the Obama administration has supported an evidence-based approach to sexual education, Congress has continued to push funding for abstinence-only-until-marriage programs. So both types of programs currently receive federal money.

According to the Sexuality Information and Education Council of the United States (SIECUS), there were two funding streams in Fiscal Year 2016 for evidence-based programs.

The Personal Responsibility Education Program receives $75 million annuallyand is given out mainly as block grants to states to support “evidence-informed or innovative approaches that offer medically accurate and age-appropriate education for adolescents.” Programs can teach about abstinence and/or contraception to prevent pregnancy and STIs.

Another funding stream that supports evidence-based programs is the Teen Pregnancy Prevention Program (TPPP), which provides a little more than $100 million to public and private entities in 33 states primarily to replicate prevention programs proven effective by research. These programs must be medically accurate, age-appropriate, and based on or informed by evidence.

Although there is no evidence that abstinence-only-until-marriage programs work to prevent teen pregnancy or STIs, the federal government continues to fund these program to the tune of $85 million per year. Most of that money ($75 million) goes through the Title V abstinence-only-until-marriage funding stream, which currently funds 35 states and two territories. States that accept the money must match every fourfederal dollars with three state dollars or in-kind services.

The other stream of abstinence-only receives only $10 million but reflects the rebranding that the abstinence industry has attempted during the last few years. Though the programs it supports are now referred to as “sexual risk avoidance” (SRA), the definition of these emerging programs prove that nothing substantive has changed. These programs are required to include medically accurate information, but they focus on what they call “voluntary self-regulation,” meaning teaching young people to avoid nonmarital sex along with risky behaviors like sexual coercion or drug use.

With the eradication of abstinence-only programs extremely unlikely, a victory for sexuality education advocates during the Trump administration would be to keep all the funding for both the good and the bad programs at current levels. However, it is more probable than not that funding for abstinence-only programs under the SRA label will increase, and very possible that at least some of the funding for evidence-based programs will dry up.

As the agency that oversees this funding and makes sure that programs follow the federal lead, HHS has a good deal of influence over programs across the country. In some cases, the agency administers the grants itself, giving it decision-making authority over which organizations receive the money and what they do with it. Even when the funds are given to states to administer, however, the federal agency is responsible for advising how these funds should and shouldn’t be used. It can, for example, be very strict about making grantees conform to the official eight-point definition of “abstinence education” like the Bush administration did, or be somewhat looser as have subsequent administrations.

There are other ways that government agencies set the agenda around sexuality education and sexual health besides controlling the purse strings. In 2010, HHS created the Office of Adolescent Health (OAH), which took responsibility for many programs, including the TPPP, as part of its effort to support prevention and health promotion activities. OAH operates at the discretion of the Secretary of HHS and, as such, may not continue to exist in the Trump administration if a new secretary doesn’t prioritize adolescent health.

It’s a Waiting Game

Ultimately, it is hard to predict what the Trump administration will do about sexuality education and how quickly it will act. The president-elect has never addressed sexuality education directly, and his positions on tangential topics suggest that he is unpredictable at best (he thinks Roe v. Wade should be overturned but called the Supreme Court decision legalizing marriage equality “settled law”). His vice president, Mike Pence, has supported an abstinence-only-until-marriage approach. Pence is also on record calling condoms poor protection against STIs and saying that the only “safe sex” is “no sex.”

As Chitra Panjabi, the president and CEO of SIECUS put it, “The radio silence from the incoming administration on adolescent health is driving uncertainty, fueling fear, and challenging the field of sex ed’s ability to plan for the future—not unlike someone subject to an abstinence-only program.”

]]>This Week in Sex: Girls Who Are Close to Their Moms Wait Longer for Sexhttps://rewire.news/article/2016/12/09/twis-girls-moms-wait-sex/
Fri, 09 Dec 2016 18:18:15 +0000https://rewire.news/?post_type=article&p=96668A Dutch study finds that girls who get along well with their mothers are more likely to put off having sex; doing good might have benefits in the bedroom; and don't think that gamers are hanging out alone with their joysticks.

]]>Staying involved in kids’ lives helps them think critically and make good decisions as they get closer to adulthood. A new study suggests that young people who are closer to their parents during adolescence are more likely to delay sex.

Researchers in the Netherlands collected and analyzed data from almost 3,000 young people ages 12 to 16 at two separate intervals, first in 2008-2009 and again in 2010-2011. That data included information about the participants’ sexual behavior and familial relationships.

They found that girls who had better relationships with their mothers were less likely to report sexual activity between the first and second waves of the study.

However, the same did not hold true for boys, and relationships with fathers did not have any significant effect on when teens in this study had sex.

Delaying sex until later in the teenage years can help prevent sexually transmitted infections and pregnancy because there is no risk in the years before a young person has sex. Older teens are also more likely to use condoms and contraception when they do become sexually active.

This study does not explain why those with good parental relationships are less likely to have sex early. One explanation could have to do with parental monitoring; parents who know where their kids are and what they are doing have more control over their behavior.

Previous research has shown that Dutch parents and U.S. parents have very different attitudes about sexuality, with the Dutch being more likely to discuss sexuality with their children. Therefore, it is unclear whether research in the United States would find the same results, but other studies here have found that parent-child communication about sex has positive results.

Nice Guys Finish First—Or at Least More Often

Canadian researchers Steven Arnocky and Pat Barclay conducted a two-part study to determine the role altruism plays in our choice of sexual partners and our overall own sex lives.

In their first study, they surveyed undergraduate heterosexual men and women asking about their altruistic behavior such as donating blood, their sexual behaviors, and their general personalities. Young people who scored higher on the altruism scale reported that they were more desirable to the opposite sex and that they had more sexual partners, including more casual sex partners. In terms of number of partners, altruism mattered more for men than for women, suggesting that more women than men find altruism a desirable trait in a mate.

Arnocky and Barclay found these results interesting but recognized that participants could have exaggerated their altruism or their sex lives. So, for the second study, they chose a more concrete way to measure altruism. They told participants that at the end of the study—which once again asked them to answer questions about their sexual history, their personality, and their perception of their own desirability—they would be entered in a raffle to win $100. They then offered participants the opportunity to donate their potential winnings to charity. They found that those who said they would donate their money reported having more lifetime sex partners, more casual sex partners, and more sex partners within the last year.

Philosophers, like Friedrich Nietzsche, have been arguing for centuries that there is no such thing as true altruism since doing good often rewards the do-gooder in concrete or intangible ways including winning praise or even just an increased sense of self-worth. As the daughter of a philosopher, I’ve always found this to be one of the more pointless debates: Who cares why we do good deeds so long as we do them? And now that we know altruists may get sexual rewards, perhaps we will see an uptick in good deeds.

Gamers May Be Having More Sex Than the Rest of Us

Stereotypes of gamers may have them sitting alone in dark basements, eating Doritos, and wearing the same concert T-shirt for weeks at a time. But a new survey pushes us to rethink these images. UNILAD—an England-based website for millennials that covers fashion, food, sports, technology, and gaming—surveyed 2,400 women older than 18 and asked them to classify their male partners as a hipster, gamer, rocker, gym goer, nerd, trendsetter, or other category (including “chav,” which may not have an easy U.S. equivalent).

Only 7 percent of women categorized their partner as a gamer but those who did had good things to say.

First, it turns out gamers are having more sex than many other men. Their partners reported intercourse six times a week compared to four times per week for hipsters and chavs. Also important, 59 percent of gamers’ partners said her man put her needs before his own. That’s compared with just 19 percent of those who had trendsetters as partners.

So, the next time someone invites you over to check out their Nintendo 64, it might be wise to say yes.

]]>Proposition 60 Ignores Unique Needs of Porn Industry, Perpetuates Falsehoodshttps://rewire.news/article/2016/11/07/prop-60-ignores-unique-needs-porn-industry-perpetuates-falsehoods/
Mon, 07 Nov 2016 17:57:00 +0000http://rewire.news/?post_type=article&p=95655In my opinion, the biggest issue with California's Prop 60 is that it was drafted without any input from the industry, as well as without any understanding of how the industry functions today. Porn performers are constantly working internally to improve upon the industry.

]]>It was July 2012, and I had just ended a second successful Skype interview with my first porn studio. I’d already been working in the sex industry for six years as a burlesque performer, stripper, and fetish model, and had been methodically courting multiple porn studios for months. I’d diligently done my research, and was more than ready to make the jump to the next chapter of my career.

In the days following my interview, I received multiple emails from the studio with a host of information about preparing for my first shoot. Some of it is what a civilian would expect: travel itinerary details, information about what kind of scene I’d be shooting, who my costar would be, recommendations on what kinds of outfits to bring to set, and so on and so forth. However, they also introduced me to the Free Speech Coalition (FSC), its Adult Production Health and Safety Services (APHSS) program, and its Performer Availability Scheduling Service program, which was developed by industry stakeholders, compliance experts, doctors, and attorneys to uphold performer testing protocols and industry standards for self-regulation. This was the first formal education I’d ever received on how the porn industry took preventive action against sexually transmitted infection (STI) transmission on set. Before being enlightened, I’d just assumed that porn stars had informal—yet informed—conversations about risk assessment and harm reduction with one another immediately prior to shooting.

At the time, performers were required to get tested every 30 days through an APHSS-approved testing facility. The tests are colloquially referred to as “Talent Tests,” and they screen for HIV, syphilis, gonorrhea, chlamydia, and trichomoniasis, as well as hepatitis B and C. Results are available within 24 to 48 hours, and are then uploaded to a national database and shared with the performer in question, as well as with all major porn production companies. If you test “positive” on any of the results, you’re prohibited from working until you re-test “negative.” Additionally, should there be a positive result, the FSC calls a moratorium, temporarily halting all industry production and launching an internal investigation to ensure that no on-set STI transmissions occurred.

To me, this system already seemed both sophisticated and comprehensive to the extreme. But a mere few days after receiving my inaugural porn shoot instructions via email, the “Mr. Marcus” scandal broke. A seasoned porn performer, “Mr. Marcus” altered a syphilis-positive Talent Test so that he could keep performing. In the weeks after he exposed his co-stars to the disease without their knowledge or consent, close to a dozen actors testified positive for syphilis. The incident sparked an industry-wide panic and an FSC-imposed ten-day moratorium while performers were all tested and treated for syphilis.

The moratorium lifted just in time for me to fly across the country and shoot my first porn scene. Before the shoot, I had to undergo three separate rounds of testing in a two-week period, as well as receive two incredibly painful penicillin injections in my ass as an additional precaution even though I was entirely new to the industry. I often tell people that the porn industry is so safe, I had to work harder to get into porn than I ever have trying to take someone to bed!

The following year, in 2013, the FSC changed testing protocols from “every 30 days” to “every 14 days” to decrease the likelihood of another outbreak. The FSC also improved the security of the testing database that ensures performer privacy and protects producer liability, and increased protocols for performer support in the event of a positive HIV-test result, including funding for testing of first- and second-generation partners.

Now, three years later, the porn industry is battling Michael Weinstein’s Proposition 60, which perpetuates the offensive, condescending, and factually inaccurate ideas: (1) that porn performers can’t be trusted to make their own health and safety decisions; and (2) that the producers and directors they work with universally don’t care about performers, and are actively trying to coerce and manipulate them into engaging in risky behavior on camera for their own personal gain.

The measure will require performers in California—one of the two states where it’s explicitly legal to shoot porn—to use condoms on set in situations that may facilitate the spread of sexually transmitted infections (STIs), including anal and vaginal sex, with condom-safe and appropriate lubricants as necessary. In addition, producers will be required to pay for any STI prevention, screening, and treatment costs incurred by performers. The requirements for film permits and notices would also be tougher under Prop 60, including mandated liaisons with the health department.

In addition, the measure “allows adult performers to bring suit against producers who break the law, and it permits any California resident to file a complaint with a state if the resident believes condoms were not used in a production.”

In my opinion, the biggest issue with Prop 60 is that it was drafted without any input from the industry, as well as without any understanding of how the industry functions today. Porn performers are constantly working internally to improve upon the industry. We have no problem prioritizing our own physical wellness, security, and sustainable success; just look at “OSHSB Petition 560.”

On May 9, 2016, the California Division of Occupational Safety and Health (Cal/OSHA) received a submission on behalf of the FSC, designated OSHSB Petition 560. This petition aims to “promulgate a safety and health standard to address the unique health and safety needs and issues faced by the adult film industry.”

So while the entire industry throws untold hours of emotional, physical, and financial labor opposing and educating people about Prop 60, advocates and the industry are engaging Cal/OSHA to determine a baseline agreement of protection that we can all support. We want to design proactive regulations that enable performers to make use of any and all preventive options that are out there now, as well as those that might be available in the future. These could include, but are no way limited to, vaccinations, pre-exposure prophylaxis (PrEP), testing protocols as they stand today (taking future advancements into consideration), latex or nitrile gloves, condoms, and dental dams.

These regulations will be different from those in Proposition 60 because they will be shaped with the industry’s direct participation and input, and will encompass a variety of protective methods, instead of creating a “condom or bust” environment.

This petition is just one of many examples proving the industry has been proactive in the fight against STI transmission. And, for the record, we are not “against” condoms in any way; the industry is pro-choice, and always has been. I myself am a condoms-only performer, although I believe that porn performers should be directly involved in creating and shaping regulations that affect both their income streams and their bodies.

The porn industry is a very unique industry, especially in the sense that the work that we do is inherently physically and emotionally intimate. By default, we have a strong, organic desire to stay safe to sustain our professional careers, as well as our bodies. Porn performers are, quite literally, sexual professionals, and the many methods we utilize to keep ourselves safe aren’t always visible.

When civilians view a porn scene without a visible condom, they’re likely to make assumptions based on an ignorance around all the invisible safety precautions we’re taking. This includes our consistent and effective testing regimens. According to Centers for Disease Control and Prevention data, only 45 percent of all general population adults have ever had a single HIV test, while active porn performers get tested an average of 26 times per year. Other preventive measures include off-camera negotiations about each individual performer’s safer sex preferences and the consumption of PrEP, otherwise known as Truvada.

Some proponents of the Prop 60 have argued that porn is an educational tool, in some ways, for youth, and therefore should only showcase “responsible,” visible protective protocols. This argument is ludicrous. Condomless sex does not inherently equal unprotected sex, and this argument diverts the conversation away from the necessity to test, as well as the need for comprehensive, pleasure-based sexual health education programs in our schools. We don’t expect our kids to learn how to drive from watching The Fast and the Furious, just like we don’t expect a gun safety public service announcement to scroll across the screen before enjoying the movie Die Hard. So why are we holding pornographic media to an entirely separate standard?

The first advisory committee addressing Petition 560 is scheduled to meet on January 31. But if Prop 60 passes, it will make all the work performers have done with Cal/OSHA moot.